After it was revealed Joran van der Sloot confessed to killing Natalee Holloway and dragging her body into the ocean, a federal judge on Wednesday noted the Mountain Brook teen was but one young woman to die at his hands.

“You have brutally murdered two women who refused your sexual advances,” U.S. District Court Judge Anna Manasco told van der Sloot.

The second to die was Stephany Flores Ramirez, a 21-year-old Peruvian business student van der Sloot brutally murdered five years to the day Natalee Holloway was killed in an eerily similar fashion as Holloway.

Van der Sloot met Ramirez while the two played poker in a Lima casino.

Ramirez was in her third year studying business administration at University of Lima, and ran the merchandising arm of the family entertainment and event-promotion business, her brother once told CNN.

She wanted to continue playing poker online so the two went to his hotel in her SUV on May 30, 2010.

“I opened my e-mail and saw a message saying, ‘I’m going to kill you, you little Mongoloid,” referring to the ‘Holloway case, according to a transcript of his confession.

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Van der Sloot said he then explained to Flores that he had been arrested and was a suspect in the disappearance.

Ramirez then struck him “on the left side of my head with her fist,” he said. Van der Sloot struck back, he said.

“I hit her hard with my right elbow and I think her head went back and hit the wall, then she begins to bleed, immediately I get on top of her and with both hands I begin to strangle her, keeping her that way for a minute. After that, I throw her to the floor but she keeps breathing. At that moment I take off my shirt and put it on her face, pressing on it. I don’t remember for how long but she stops breathing, in this way I think I caused her death.”

Asked why he did it, van der Sloot said: “I lost control of my actions, I didn’t know what I was doing. I remember what I was doing but not the motive. It was an impulsive act after receiving a blow to the head.”

Van der Sloot then fled the hotel, telling staff not to bother “his girl,” police said. He took her gambling winnings and belongings from her SUV. His confession to Ramirez’s murder did not mention him attempting to have sex with her.

“The only thing I wanted was to leave the scene of the crime as quickly as possible and afterward leave the country.”

A maid found her body. Her neck had been broken.

He was arrested in Chile and sent back to Peru. In 2012, he pleaded guilty to murder and was sentenced to 28 years.

For Ramirez’s family, the death was devastating.

“My sister is very friendly … always smiling, always nice,” Enrique Flores told CNN. “I think about how she felt with him, that she probably did not think … and it is … so hard to think about that…My sister was the only girl in our house, the queen of our family.”

“This isn’t a coincidence, this murder,” her father, Ricardo Flores, told AP in 2010. “It’s not just about my daughter. There’s a matter pending in Aruba and we don’t know how many more remain unpunished.”

The attorney for her family of the victim argued for life in prison saying “psychological examinations .. concluded that he is a psychopathic person.”

Van der Sloot’s lawyer blamed the killing on “severe emotional reaction to extreme psychological trauma” over being accused of killing Holloway.

Two months before Ramirez was murdered, van der Sloot attempted to extort $250,000 from Beth Holloway, falsely promising to lead the mother to Natalee’s body.

He later admitted he lied and was charged by federal authorities.

As part of a plea deal in that case, van der Sloot revealed how Natalee Holloway died on May 30, 2005. The circumstances were largely the same in the two murders.

Van der Sloot said while he and Natalee were alone on a beach the two kissed and he began “feeling her up” when she told him no.

“She tells me she doesn’t want me to feel her up…..Uh, I insist. I keep feeling her up either way,’’ van der Sloot said. “Uhm, and uh, she knees me uh, she ends up kneeing me in the crotch.”

“When she knees me in the crotch, uh, I get up, uh, on the beach and I kick her extremely hard in the face,’’ a transcript of his confession states. said. “She’s laying down unconscious, possibly even dead, but definitely unconscious.”

Van der Sloot said he then smashed her head in with a cinder block he found. “I walk up to about my knees into the ocean and I push her into the – into the sea. Uhm, and uhm, yeah, after that I – I get out. I- I walk home.”

He will not be charged in the U.S. in Natalee’s death and is unlikely to be charged in Aruba. He is set to be released from a Peruvian prison in Ramirez’s murder in 2043.

If he is freed before then, he will serve the rest of a 20-year sentence for extorting Beth Holloway in the U.S.

“Your life was pretty much over in 2010 when you extorted me and then killed another beautiful young woman in Peru, five years to the day after you killed Natalee,” Beth Holloway said.